Friday, August 31, 2012

By Raphael Ahren
One of Germany’s most prominent rabbis has been charged after
publicly vowing to continue to perform circumcisions, The Times of
Israel has learned.

The office of Rabbi Yitshak Ehrenberg, who has been serving the
Berlin Jewish community since 1997, on Wednesday confirmed in an email
that criminal charges had been filed against him. Ehrenberg has received
a letter from the prosecutor’s office because of comments he made on a
nationwide broadcast television show, an aide confirmed. At this point
it is not known who filed the complaint and what exactly the letter
states.

Ehrenberg could not immediately be reached for comment.
...
On July 11, Ehrenberg ... participated in a debate on “Anne Will,” a
popular talk show dedicated to the Cologne ruling and its implications
[link in German].

“I don’t even want to go into this discussion,” Ehrenberg said after a
proponent of a ban said that the act was tantamount to causing the
child bodily injury without his or her consent. “We’re talking about
religion,” said Ehrenberg. “This ruling will kill Judaism in Germany.”

After more than an hour of lively discussion, host Anne Will allowed
Ehrenberg the last word. The rabbi first appealed to his congregants not
to have their children circumcised in a hospital but in a synagogue or
at home. Then he concluded: “Circumcision is a basic law for us Jews.
There is no Judaism without circumcision, and therefore — we will
continue.”

The national consensus on the mutilation of every newborn male

By Eyal Meged
...

It's an irony of fate that the Germans, of all people, are calling us
to order in Jewish matters. It's an irony of fate that they are the
ones telling us the religious precept, which even complete heretics
among us keep without blinking an eye, is a barbaric, primitive act, not
to say a violation of the law.

...

What disaster would have befallen had the president turned to us, his
flock, and asked us to reconsider the automatic sacrifice of every
Jewish male on the circumcisers' altar? I too had to go through most of
my life and two male sons before I acknowledged the sin of circumcision,
which I committed light-headedly.

If we think rationally for one moment, why should the Germans - and
the Swiss who followed their lead, or any other Western state - allow a
Jewish rabbi to perform a surgical act forbidden to anyone else who
isn't a doctor? What chutzpah on our part to ask for ourselves a
privilege that is a blatant infraction of the law, which is intended to
protect people from various charlatans.

Tuesday, August 28, 2012

Benefits of Circumcision Are Said to Outweigh Risks

By Roni Caryn Rabin
The American Academy of Pediatrics has shifted its stance on
infant male circumcision, announcing on Monday that new research,
including studies in Africa suggesting that the procedure may protect
heterosexual men against H.I.V., indicated that the health benefits
outweighed the risks.

But the academy stopped short of recommending routine circumcision for all baby boys, saying the decision remains a family matter. The academy had previously taken a neutral position on circumcision.

The new policy statement, the first update of the academy’s
circumcision policy in over a decade, appears in the Aug. 27 issue of
the journal Pediatrics. The group’s guidelines greatly influence
pediatric care and decisions about coverage by insurers; in the new
statement, the academy also said that circumcision should be covered by
insurance.

The long-delayed policy update comes as sentiment against
circumcision is gaining strength in the United States and parts of
Europe. Circumcision rates in the United States declined to 54.5 percent
in 2009 from 62.7 percent in 1999, ...

Officials with the Centers for Disease Control and Prevention in
Atlanta, which for several years have been pondering circumcision
recommendations of their own, have yet to weigh in and declined to
comment on the academy’s new stance. Medicaid programs in several states
have stopped paying for the routine circumcision of infants.

“We’re not pushing everybody to circumcise their babies,” Dr. Douglas
S. Diekema, a member of the academy’s task force on circumcision and an
author of the new policy, said in an interview. “This is not really
pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a
better word. Really, what we’re saying is, ‘This ought to be a choice
that’s available to parents.’ ”

But opponents of circumcision say no one — not even a well-meaning
parent — has the right to make the decision to remove a healthy body
part from another person.

“The bottom line is it’s unethical,” said Georganne Chapin, founding
director of Intact America, a national group that advocates against
circumcision. “A normal foreskin on a normal baby boy is no more
threatening than the hymen or labia on your daughter.”

In updating its 1999 policy, the academy’s task force reviewed the
medical literature on benefits and harms of the surgery. It was a
protracted analysis that began in 2007, and the result is a 30-page
report, which includes seven pages of references, including 248
citations.

Among those are 14 studies that provide what the
experts characterize as “fair” evidence that circumcision in adulthood
protects men from H.I.V. transmission from a female partner, cutting
infection rates by 40 to 60 percent. Three of the studies were large
randomized controlled trials of the kind considered the gold standard in
medicine, but they were carried out in Africa, where H.I.V. — the virus
the causes AIDS — is spread primarily among heterosexuals.
Circumcision does not appear to reduce H.I.V. transmission among men
who have sex with men, Dr. Diekema said. “The degree of benefit, or
degree of impact, in a place like the U.S. will clearly be smaller than in a place like Africa,” he said.

Two studies have found that circumcision actually increases the risk of H.I.V. infection among sexually active men and women, the academy noted.

Other studies have linked male circumcision to lower rates of
infection with human papillomavirus and herpes simplex Type 2. But male
circumcision is not associated with lower rates of gonorrhea or
chlamydia, and evidence for protection against syphilis is weak, the review said.

The procedure has long been recognized to lower urinary tract
infections early in life and reduce the incidence of penile cancer.

Although newborn male circumcision is generally believed to be relatively safe, deaths are not unheard of, and the review noted that “the true incidence of complications after newborn circumcision is unknown.”
Significant complications are believed to occur in approximately one in 500 procedures. Botched
operations can result in damage or even amputation of parts of the
penis, and by one estimate about 117 boys die each year.

Anesthesia is often not used, and the task force recommended that
pain relief, including penile nerve blocks, be used regularly, a change that may raise the rate of complications.

The Intactivism Pages say:

The American Academy of Pediatrics policy on male genital cutting is flawed and culturally biased. It should be withdrawn.

It fails to consider the structure or functions of the foreskin, a normal healthy body part, only cutting it off.

It claims benefits of circumcising outweigh the risks without ever numerically comparing them.

It exaggerates benefits and minimizes risks and harm:
For example -

It cites a study showing that circumcision removes the most sensitive part of the penis and ignores that finding.

It admits the African HIV findings may not be applicable to the USA, but goes ahead and applies them.

It cites a study suggesting circumcising men increases the HIV risk to women, and ignores that finding.

It cites a study showing that a narrow foreskin, not a normal one, is the issue in penile cancer, and ignores that finding.

It dismisses major complications and death from circumcision because it didn't find any statistical studies of them.

It discusses the action of the Mogen circumcision clamp
without mentioning that the clamp has caused too much of several boys'
penises to be cut off; lawsuits have driven the company out of business.

It repeats the common claim that it is safer to circumcise babies than adults, but offers no evidence for that claim.

Its ethical consultant has said elsewhere that circumcision is
not necessary and has a risk of harm, and that a parental wish is not
sufficient to justify doing any surgery, and it ignores that.

The AAP should withdraw its circumcision policy the way it withdrew
its female genital cutting policy after a storm of outrage two years
ago, when it recommended a token ritual nick to baby girls, much LESS
extensive than neonatal male genital cutting. If that was unacceptable,
how can this be acceptable?

Denmark to probe whether circumcision violates health code

“We will examine the public health recommendations followed in this
area,” Danish Prime Minister Helle Thorning-Schmidt told the
Copenhagen-based Politiken daily on Saturday.

Politiken reported that the Danish government has commissioned a
study on this question. Last month the paper published an expose that
said the National Board of Health did not monitor the conditions under
which circumcision takes place.

Non-medical circumcision of minors has been the subject of a heated
debate in Denmark over the past few months. Several politicians
reportedly have called for a ban on the practice, prompting angry
reactions from Jews and Muslims.

Venstre, Denmark’s largest party, will decide whether to seek a ban
on such circumcisions based on the results of the study, a party
spokesperson told JTA.

The chief rabbi of Denmark, Bent Lexner, told Politiken that he did
not think the launching of the investigation reflected distrust on the
government’s part. He said the government was welcome to carry out its
investigation.
...

Sunday, August 26, 2012

Leaks distort AAP's already-biased policy

By Hugh Young
Websites supporting circumcision have leaked the American Academy
of Pediatrics' policy on circumcision, adding further spin to an
already biased policy.

The Tablet trumpets "Leading Pediatric Group Endorses Circumcision" and this has been echoed on other conservative sites.

They do NOT "endorse" it. They say "health benefits are not great
enough to recommend routine circumcision for all male newborns" but the
benefits outweigh the risks and then, as they always have, leave it up
to parents.

Their policy exaggerates the benefits and minimizes the risks. For
example, there are no good statistical studies of major complications or
deaths, so it simply ignores them. It cherry-picks data and
misrepresents it. For example it cites a study that found "circumcision [removes] the most senstive part of the penis"
but ignores that finding - in fact it ignores the foreskin as much as
it can, neither defining it nor considering its unique structure and
many functions.

It discusses one circumcision clamp's
action without mentioning that its maker has gone out of business after
losing lawsuits worth millions to the families of boys who lost too
much in the clamps.

Its pro-circumcision bias is manifest - as is its financial interest
in getting your taxes and health insurance premiums into their pockets
through public funding of circumcision.

As one satirist put it:
An earnest, overachieving group of middle school students proudly turns in a 3-year term paper entitled:

Forty Reasons Why Circumcision Is a Really Good Thing

by Cathie Cutup and her 8 friends

when the assignment was, in fact,

Juvenile Male Anatomy:How It Looks, How It Works and How to Keep it Healthy.

They exhaustively answered the wrong question, and delved deeper into
wrong than anyone thought humanly possible. They get an "A" for effort
and an "F" overall on the assignment....

There never should have been a "Task Force on Circumcision", because
everything looks like a nail when you're a hammer. If the AAP is so
concerned with the health of the penis, then they should have had a Task
Force on Male Urogenital Health and Development, and just observed in
passing that unnecessary circumcision was an odd religious thing,
outside the realm of ethical medicine. Period.

Trainer: You exhaustively answered the wrong question, but thanks for playing". Bzzt!

Bottom line: the AAP does not recommend circumcision. It is still true that no national medical association in the world does.

Fashion show for expectant moms at SITF

By Phumla Dlamini
PSI Swaziland invites all expectant mums and dads to a Baby Fair
on September 3 at the Mavuso Trade Centre. The event will coincide with
the ongoing Swaziland International Trade Fair (SITF).

The Baby Fair is part of the ‘Lugotjwa Lusemanti’ campaign that seeks to encourage early circumcision of the boy child.

highlight
The main highlight on this day will be a fashion show, which will see pregnant women parading fashionable maternity wear.

...

scanning
Due to popular demand at the previous trade fair, there will also be a
sex scanning machine which will be available for the first 50 women to
utilise.[...so they can browbeat those expecting boys before they are born]
...

Mothers willing to have their babies circumcised must come through because it will be done for free.[Hurry! This price won't last!]
...

Denmark to review male circumcision practices

COPENHAGEN (AFP) - Denmark has commissioned a report into whether
male circumcision is always carried out in line with national health
guidelines, the prime minister said on Thursday.

Controversy surrounding the non-medical circumcision of young boys
arose earlier this summer when Danish media revealed that the National
Board of Health did not monitor the conditions under which circumcision
takes place.

"We must make sure that things take place in a proper way. And the
government is taking the initiative to do so. We will investigate
whether the National Board of Health recommendations are being met,"
Prime Minister Helle Thorning-Schmidt told a national daily.

Under the health board rules, a doctor must be present during male circumcision...

Peres to German president: End circumcision row

By Benjamin WeithalGerman Ethics Council conditionally supports the ritual, following an anti-circumcision ruling in Cologne.

President Shimon Peres called on German President Joachim Gauck on
Thursday to resolve the German legal issues around circumcision, Army
Radio reported.

...

The controversy follows a criminal complaint filed this week by a
physician in Germany against Rabbi David Goldberg, a mohel based in Hof
Saale, Bavaria, for performing brit mila.
Germany's Ethics Council came out in conditional support of
circumcision, its chairwoman Christiane Woopen said Thursday following a
council meeting.

[So how did it address the statement in the Grundgesetz (Basic Law) that"Every person shall have the right to life and physical integrity. Freedom of the person shall be inviolable."?]
According to German media, Woopen said that the agreement of both parents should be necessary, the possibility of anesthesia should be introduced to alleviate pain and there should be comprehensive education about the risks associated with circumcision.

Additionally, the procedure should be carried out by medical professional. [...like the one who botched the Muslim boy in Cologne....]
The members of the ethics council recommended a committee consisting
of Jews, Muslims, parent groups and doctors from various disciplines to
participate in clarifying Germany's position on the issue. According to
reports, members of the Ethics council had differing views on the
ritual's place in Germany.

Hamburg-based legal expert Reinhard Merkel stressed at the meeting
that he considers circumcision without anesthesia to be" legally and
ethically not acceptable." He added this should not be allowed to take
place.

The deputy representative of the ethics council, the evangelical
theologian, Peter Dabrock, advocated for "proven effective pain therapy
measures" for the procedure.

However, the Cologne legal expert, Wolfram Höfling, said it is
necessary to have a "recognition of circumcision as a parental right."
He conditioned his advocacy of circumcision on the avoidance of pain
during the process.

Leo Latasch, a Jewish physician on the council, suggested he was
amenable to a local anesthesia. He said anesthesia is already a
customary method in Germany. Latasch flatly rejected that circumcision
of young boys is comparable with genital mutilation of young
girls.According to Latasch, medical complications take place in less
than 0.2 percent of the cases by circumcision and there is no proof
that the procedure results in traumatic after effects.

The Muslim medical ethicist Ilhan Ilkiliç called for a "factual"
debate. He warned of operations in back rooms without supervision and a
"circumcision tourism" if lawmakers do not react to the Cologne decision
criminalizing circumcision.[The fear of backroom cutting has never deterred bans on FGC - except briefly, in AAP policy.]
...

According to the DPA news service, the authorities in Bavaria are examining the complaint for "criminal relevancy."

However, following the Cologne ruling Bavarian authorities said that they would not enforce the decision in their state.

Circumcision debated

Germany's national Ethics Council (Ethikrat) has recommended authorising circumcision if safeguards are in place. ...

But the recommendation was made after a robust debate. A legal scholar, Reinhard Merkel, said that it was "bizarre" that religious communities could be allowed to define when and how a human body could be injured.
If a child's right to bodily integrity had to be weighed against
religious requirements, this was a "legal policy crisis". However, he
squared the circle by invoking an "indebtedness" to Jews which called
for a "special law". [Would this "indebtedness" apply outside Germany? And would the special law include Muslims?]
Constitutional law expert Wolfram Höfling, on the other hand, argued
that parental rights were paramount. If they believed that the ritual
was in the best interests of the child then this should be respected,
especially since millions of circumcisions have occurred without
complications. [Complications are not the only issue.]

Call for circumcision device probe

By Nosihle Shelembe
Durban - The Treatment Action Campaign has asked the Public
Protector to investigate the procurement and ongoing use of a device
used to perform medical male circumcisions in KwaZulu-Natal.

...

“The TK [Tara KLamp] is a dangerous device. It has specifically not
been approved by the World Health Organisation because it failed in the
only clinical trial conducted to test its safety,” [TAC provincial
chairman Patrick] Mdletshe said.

The TK is a plastic device which is clamped over the foreskin of a
man’s penis for seven to 10 days until the foreskin falls off. Sometimes, the device has to be surgically removed.

The TAC said the TK was used only in KwaZulu-Natal, as all the other provinces had rejected it.
Using TK cost R120 more per circumcision than the standard surgical method, Mdletshe said.

A man who did not want to be named, and who was circumcised using the
TK, said that before the procedure, his penis had not been measured
when it was in an erect state.

“At about 3am in the morning, when I get my erection, it becomes very painful as my penis size increases,” he said.

...

“In January 2012, we received a draft document outlining the research
carried out. However the methodology of this research was so poor it
provided no evidential value regarding the safety of the TK,” Mdletshe
said.

Trials of the TK on adults in Orange Farm showed that it was unsafe.

The trials revealed that there was a 32 percent infection rate using the TK compared to the zero percent when using the forceps guided method (FGM), which was the standard surgical method.

The complication rate when using the TK was 37 percent compared to three percent using the FGM.
According to the TAC, no tender had been published for the procurement of the TK.

“The TK was purchased from a supplier with links to government, rather than a competitor offering a low price,” Mdletshe said.

Friday, August 24, 2012

Attorneys for the Rights of the Child Condemns American Academy of
Pediatrics for Hiding the Truth, Putting Doctors Ahead of Patients in
its Circumcision Statement

Berkeley, CA – The human rights group Attorneys for the Rights of the Child
(ARC) has condemned the American Academy of Pediatrics (AAP) for its
upcoming “Circumcision Policy Statement,” due out on August 27, 2012,
which ignores and minimizes the truth about male circumcision and places
doctors’ interests ahead of patients’ needs. J. Steven Svoboda, ARC’s
Executive Director, commented today, “Based on comments that have
appeared in the media attributed to members of the task force preparing
the statement, the AAP appears to endorse a disproven procedure that
violates the infant patient’s rights and removes functional tissue
without providing any proven benefit.”
The AAP position statement ignores the wealth of medical evidence
that painfully amputating functional tissue from newborns is a dangerous
and outmoded practice.”

Not a single study has ever proven that circumcision has actually
decreased any disease in the United States. Svoboda observed, “Rather
than objectively evaluating all available evidence, the AAP selectively
quotes and references highly contested and controversial studies to
attempt to justify an entrenched yet outmoded cultural—not
medical—practice. Over a hundred boys die each year from this needless
procedure, yet the AAP quotes an absurdly low overall complication rate
overall and fails to mention the deaths stemming from the practice.”

The AAP released a policy statement in 2010 in Pediatrics defending
certain forms of female circumcision if performed for “cultural”
reasons. Physicians who had followed the AAP’s suggestion at that time
would have thereby violated federal law protecting females from such
procedures. After ARC and other organizations opposing genital cutting
pointed out the errors, the AAP quickly retracted its statement and
replaced it with a new statement calling for the elimination of all
forms of female genital cutting. Svoboda commented, “Boys deserve no
less protection from the AAP than girls received. If circumcision is so
great, why have no European countries adopted it, and why do their males
enjoy better average health than Americans?”

The AAP statement demonstrates its ignorance of the fact that
European men don’t circumcise and yet enjoy better health outcomes
including the areas the statement cites as improved after circumcision.
Moreover, medical organizations and politicians in Finland, Sweden,
Norway, the Netherlands, Germany, Switzerland, Austria, and other
countries are calling for the practice to stop. Even in the US, the
American Medical Association (AMA) agrees that there is insufficient
justification for performing the procedure on newborns absent specific
medical indications.

Svoboda noted that studies of adult males in Africa have numerous
methodological flaws and that even if valid, given vast differences in
health conditions and modes of transmission between the US and Africa,
the results can hardly be applied to justify infant male circumcision in
the United States. “Babies don’t get HIV and AIDS from sexual
contact,” Svoboda added.

“Male circumcision,” Svoboda said, “is a disfigurement that carries
risks without providing benefits. It violates a child’s right to bodily
integrity, not to mention numerous civil and criminal laws.” Malpractice awards are mounting up including a recent $700,000
settlement reported in the Massachusetts Lawyers Weekly. Svoboda noted,
“Although the AAP’s statement regarding male circumcision is presumably
influenced by its desire to protect its members who perform the
outmoded procedure, the AAP has no business promoting a harmful and
discredited cultural relic masquerading as a medical procedure. In
these days of rising medical costs and scarce resources, we simply
cannot afford to continue to carry out such a harmful and outmoded
practice.”

Americans are getting the message, as according to the Centers for
Disease Control and Prevention (CDC), rates have dropped substantially
in recent years.

Attorneys for the Rights of the Child is a non-profit organization
founded in 1997 to protect children from unnecessary medical procedures
to which they do not consent.

Group Opposed to the Non-Therapeutic Genital Cutting of All
Children Calls AAP “Shockingly Biased and Out of Touch with Medical
Ethics and Children’s Rights”

TARRYTOWN, NY—Intact America, an organization founded in 2008 to
ensure that all children are protected from permanent bodily alteration
inflicted on them without their consent, is criticizing the anticipated
August 27 release by the American Academy of Pediatrics (AAP) of its new
“Circumcision Policy Statement.” Based on comments to the press
made by members of the AAP’s Task Force on Circumcision, which authored
the document, Intact America deplores the Statement’s focus on
selective evidence supporting medical benefits of removing normal
foreskins from baby boys.

Georganne Chapin, Executive Director of Intact America, stated today,
“From the AAP Circumcision Task Force’s pre-publication comments, it is
clear that the group has chosen to feature only literature (almost
exclusively focused on adult men in Africa) that supports its
predisposition toward circumcising boys; the Task Force has failed to
consider the large body of evidence from the developed world that shows
no medical benefits for the practice, and has given short shrift, if not
dismissed out of hand, the serious ethical problems inherent in doctors
removing healthy body parts from children who cannot consent.”

In 2010, Intact America responded similarly when the AAP issued a new
Policy Statement on Ritual Genital Cutting of Female Minors; this
statement called for doctors to be allowed to inflict a “ritual nick” on
infant girls’ genitalia for “cultural” reasons, in contravention of
Federal law prohibiting any such cutting. The AAP’s policy statement
also acknowledged that, “Some forms of FGC [performed in African
cultures] are less extensive than the newborn male circumcision commonly
performed in the West.” Pressure from Intact America and other groups
opposing Female Genital Mutilation resulted in the quick retraction of
the AAP’s call for tolerance of and doctors’ participation in the ritual
cutting of baby girls, and in the issuance of a revised policy
condemning “all types of female genital cutting that pose risks of physical or psychological harm.” Intact America maintains that any alteration or cutting performed on
the normal, healthy genitalia of minors is an unethical act that ignores
the well-established right of all individuals to bodily integrity.

“It is clear,” said Ms. Chapin, “that the AAP is blind to the
mounting worldwide movement against the genital cutting of boys. This
American physician organization is disregarding the risks and harms of
the procedure. It also is ignoring the fact that circumcision is rare in
Europe, with no negative health consequences, and that European
politicians and physician groups—in increasing numbers—are calling for
doctors to refuse to perform the procedure, on the basis that it is
harmful and violates children’s rights and bodies. In its selective
blindness, the AAP has failed to put the wellbeing of the infants and
children it is supposed to protect ahead of that organization’s cultural
bias and interest in perpetrating a medically unnecessary, harmful, and
unethical practice.”

About Intact America
Intact America was formed in 2008 to change the way America thinks about
neonatal male circumcision. Intact America believes that painful and
medically unnecessary surgery to remove healthy genital tissue from
non-consenting baby boys violates medical ethics and human rights.
Intact America is based in Tarrytown, N.Y. Visit Intact America at
www.intactamerica.org, on Facebook, and on Twitter.

The American Academy of Pediatrics (AAP) revealed that it intends to
publish its sixth major circumcision policy on Monday, August 27, 2012
and in the September 2012 issue of Pediatrics, its house journal.
This will be its sixth position statement on male circumcision, as it
has previously published position statements in 1971, 1975, 1983, 1989,
and 1999.

The new AAP policy has been five years in the making. The intent to publish a new statement was announced in 2007, however internal disagreement on its content has prevented publication. The new statement likely will be a compromise between positions.

The AAP, despite its high sounding academic name, actually is a trade
association of pediatric doctors. Its primary duty is to advance the
business and professional interests of its 60,000 members who are called
"fellows". The interests of its child-patients are a distant second to
their primary interest.

There is a severe and intractable conflict of interest between the
financial interests of its fellows and the best interests of the
child-patient. Most of its fellows perform non-therapeutic circumcisions
on children and profit thereby. These members do not want anything to
interfere or disrupt their steady income stream. The AAP will not
publish a statement that would harm that income stream. The AAP ensures
the outcome of its circumcision statements by appointing doctors who are
known to have a pro-circumcision position. The current task force, like
previous task forces on circumcision, is stuffed with pro-circumcision
doctors, including its chairwoman. Obstetricians and family doctors also
profit by doing unnecessary circumcisions. The presence on the task
force of a representative from the American College of Obstetricians and
Gynecologists (ACOG) and the American Academy of Family Doctors (AAFP),
as well as Dr. Stephen Wegner, MD, JD, representing the AAP Health Care Financing Committee,
highlight the business and financial nature of the forthcoming
circumcision policy statement. We anticipate a very self-serving
statement that protects doctors' income.

Previous AAP circumcision statements have exaggerated the alleged but
unproved prophylactic benefits of non-therapeutic circumcision while
minimizing the risks, complications, drawbacks, permanent irreversible
physical, sexual, and emotional injury of male circumcision. We expect
that this one will use prevention of HIV sexual transmission as a reason
to circumcise boys, even though the African studies that indicate
circumcision prevents HIV infection in adult males have been shown to be
trash and, in any event, not applicable to infants boys in North
America.

In recent years, 46 percent of boys born in the
United States have left the birth facility with intact foreskins. There
is not a shred of evidence that these boys are less healthy than the 54
percent of boys who were circumcised.

Doctors who perform circumcisions have had their income stream
curtailed by the decision of eighteen state Medicaid agencies to
terminate payments for medically unnecessary non-therapeutic
circumcision of children. The AAP is expected to call for restoration of
those taxpayer-funded Government payments to doctors, so as to restore
the income of their fellows.

The AAP, thus far, has consistently refused to recognize that
children are human beings, who have legal rights to bodily integrity and
the security of their person under both American law and international
human rights law, which are trampled by the unnecessary amputation of
the functional body part called the foreskin. The AAP has consistently
misapplied legal rules regarding surrogate consent for therapeutic
operations on children to non-therapeutic circumcision. By so doing, it
has tried to protect the alleged parental right to cut body parts from
boys at will for religious cultural reasons or no reason at all.

As noted above, the AAP is simply a trade association, which advances
the perceived interests of its fellows. Its position statements are not
legal or medical imperatives and do not have the force of law or public
policy. This statement on circumcision is going to be all about money,
not about child health or welfare.
The Royal Dutch Medical Association
has called male circumcision a human rights violation and an unethical
practice. The AAP's forthcoming pro-circumcision policy is not supported
by foreign medical associations.

A court in Cologne, Germany says parents may not grant consent for
unnecessary circumcision. We will see shortly whether the AAP will
reform its abusive practices. We are not hopeful.

Doctors Opposing Circumcision
believes that circumcision of children violates numerous legal rights
of the child and is highly unethical, if not unlawful. We believe that
genital integrity provides the highest level of health and well being
for the child. We do not know what the AAP is going to say in their new
statement, but we are circumcision experts and we are convinced that
non-circumcision is best for children. We reaffirm our Genital Integrity Policy Statement of 2008, which advocates genital integrity for boys.

We urge parents to ignore this latest statement from the AAP and to continue to protect their sons' whole and complete bodies.

German lawmakers work on legislation to protect circumcision

By Renuka Rayasam
BERLIN - Israel’s top rabbi is in Berlin to rally support among
German political leaders regarding legislation to protect the practice
of ritual circumcision in Germany, which was called into question
earlier this year by a controversial court ruling that Jewish and Muslim
leaders said threatened their religious freedom.

In June, after a Muslim boy suffered health complications from the
practice, a court in the western German city of Cologne declared
nonmedical circumcision to be criminal because it causes children bodily
harm. Amid outrage from some religious groups, lawmakers quickly passed
a resolution promising legislation guaranteeing legal protection for
circumcision.

This week, officials have been meeting with Yona Metzger, chief rabbi
of Israel's Ashkenazi Jews, to craft legislation on the issue. But the
stakes were raised further Tuesday after a doctor in the southern German
city of Hof, in Bavaria, reportedly filed charges with local
prosecutors against a rabbi there to stop the practice. Prosecutors must
still decide whether to act on the charges, which the Council of
European Rabbis described as a “grave affront to religious freedom.”

“This latest development … underlines the urgent need for the German
government to expedite the process of ensuring that the fundamental
rights of minority communities are protected,” the council said in a
statement on its website. [Never mind the fundamental rights of children.]
... But finding a compromise hasn’t been so simple, with opponents of
the practice saying that what they see as protecting the rights of
children should come above religious freedom. [Note
the loaded language, and the assumption that freedom of religion
entails the freedom to cut parts off non-consenting people's genitals -
not just what some other people "see it as".]
The European rabbis’ council says that using anesthesia or having a doctor perform circumcision instead of a mohel would not be in accordance with Judaism.
Metzger told reporters Tuesday that he suggested establishing a school
for mohels in Germany with both religious training from rabbis and
medical training from doctors in case of complications from
circumcision.

Wednesday, August 22, 2012

Criminal charges filed against German rabbi for performing circumcisions

By Raphael AhrenDavid Goldberg, who oversees a 400-member strong community in
northern Bavaria, is the first mohel to be charged since Cologne court
banned the ritual
For the first time, criminal charges have been pressed against a
German rabbi for performing circumcisions, a Jewish weekly reported on
Tuesday.

A doctor from Hesse filed a criminal complaint against Rabbi David
Goldberg, who serves in the community of Hof, in Upper Franconia
(northern Bavaria), according to the Juedische Allgemeine weekly
newspaper. The chief prosecutor of Hof confirmed that charges had been
filed against the rabbi. The charges are based on the controversial
decision of a Cologne district court, which ruled in June that
circumcisions for religious reasons constitute illegal bodily harm to
newborn babies.

“I am shocked,” said Cologne Rabbi Yaron Engelmayer, co-chairman of
the national umbrella group of Orthodox rabbis in Germany, in a first
reaction to the report. This marks the first time that a court in the
Federal Republic of Germany is investigating a rabbi for performing a
religious ritual, Engelmayer told the paper.

Goldberg, a qualified mohel (ritual circumciser) who says he has
performed more than 3,000 circumcisions, was informed about the criminal
charges against him by journalists, the paper said.

Born in Jerusalem, the 64-year-old has been the rabbi of Hof since
1997. Before World War II, about 3,000 Jews lived in Hof. Today, the
community counts about 400 members.

“This latest development in Hof is yet another grave affront to
religious freedom and underlines the urgent need for the German
government to expedite the process of ensuring that the fundamental
rights of minority communities are protected. We call upon the Minister
of the Interior to take immediate action to secure those rights in the
short term,” Conference of European Rabbis, Chief Rabbi Pinchas
Goldschmidt said.

The Cologne court decision caused a major uproar in Germany’s Jewish
and Muslim communities, leading the Bundestag to pass a joint resolution
calling on the government to ensure legal certainty for ritual
circumcisers. “A medically professional circumcision of boys, which does
not cause unnecessary pain” should be “generally permissible,” the
resolution read.

While the Jews in Germany feared the implications of the Cologne
ruling, they expressed confidence last month that they would be able to
continue performing the rite.

“At the moment — in our view — the verdict formally does not severely
affect the ability to perform circumcision since the decision of the
court is formally not binding for other cases,” the secretary-general of
the Central Council of Jews in Germany, Stephan Kramer, said.

Rabbi Engelmayer, from Cologne, told The Times of Israel in July that
the court decision had “enormously” impacted Jewish life in his
community. “De facto it looks as if doctors across the country are
afraid [to perform circumcisions],” he said.

“The mohels are inquiring, and we tell them: without circumcision,
there is no Judaism,” he said at the time. “Therefore it is hard to
imagine how the courts could criminalize a correctly performed Jewish
circumcision ceremony. It would be too harsh a sign, especially from
Germany.”

Engelmayer added: “I think that Germany will refrain [from
permanently outlawing circumcisions], also in light of the chorus of
outrage, the criticism and the damage it could do to Germany’s image in
the world.”

Accord Sought in Germany Over Circumcision Issue

BERLIN — German officials have been
meeting here with Israel’s chief Ashkenazi rabbi over the past two days
as they seek a way to enshrine some sort of legal protection for Jews
and Muslims who circumcise infant boys as a religious rite, officials
said Tuesday.

... Hof prosecutors could not be reached for comment, and it was
unclear whether any decision had been made to open an investigation and
press charges.

David Goldberg, the rabbi reported to have been named in the file,
said in a telephone interview that the prosecutor’s office had not yet
contacted him and that he had learned of the petition against him only
from local news media. Rabbi Goldberg said he had not carried out any circumcisions in Germany since June 26, but had been called abroad several times to perform the rite. “There is not so much demand in Germany,” he said.

On Thursday, Germany’s Ethics Council, an independent body made up of
26 members who specialize in various scientific, ethical, social and
legal concerns, is to hold a public discussion on the circumcision
debate.

As circumcision declines, health costs will go up, study projects

By Eryn BrownA team of researchers estimates that every procedure not
performed could lead to significant increases in lifetime medical
expenses because of STDs.

Declining rates of circumcision among infants will translate into
billions of dollars of unnecessary medical costs in the U.S. as these
boys grow up and become sexually active men, researchers at Johns
Hopkins University warned.

In a study published Monday in the Archives of Pediatric and
Adolescent Medicine, a team of economists and epidemiologists estimated
that every circumcision not performed would lead to significant
increases in lifetime medical expenses to treat sexually transmitted
diseases and related cancers — increases that far surpass the costs
associated with the procedure.

Circumcision is a hotly debated and emotional issue in the U.S.,
where rates have been falling for decades. In the 1970s and 1980s, about
80% of baby boys were routinely circumcised in hospitals or during
religious ceremonies; by 2010, that figure had dropped below 55%,
according to the Centers for Disease Control and Prevention.

Some of that decline is due to shifting attitudes among parents, but
at least part of it can be traced to the decision by many states to
eliminate Medicaid coverage for the procedure in order to save costs.
Today 18 states, including California, do not provide Medicaid coverage
for the procedure, which is considered cosmetic by many physicians.

But in the last decade, studies have increasingly shown that removing
the foreskin of the penis has significant health benefits, said Dr.
Aaron Tobian, senior author of the new study.

Three randomized trials in Africa have demonstrated that circumcision
was associated with a reduced risk of contracting HIV, human
papillomavirus and herpes simplex in men. One of those studies
documented a reduced risk of HPV, bacterial vaginosis and trichomoniasis
in the female partners of men who were circumcised.

Circumcision is believed to prevent STDs by depriving pathogens of a
moist environment where they can thrive. The inner foreskin has been
shown to be highly susceptible to HIV in particular because it contains
large numbers of Langerhans cells, a target for the virus.

Tobian and his colleagues developed a computer-based simulation to
estimate whether declining circumcision rates would lead to more STDs
and thus higher medical costs.

If circumcision rates remained about 50% instead of the higher rates
of years past, the lifetime healthcare costs for all of the babies born
in a single year would probably rise by $211 million, the team
calculated.

[This has not been the experience of
the rest of the developed world, such as the English-speaking world,
where the experiment of mass circumcision was tried and abandoned.]
If circumcision rates were to fall to 10% — which is typical in
countries where insurance does not cover the procedure — lifetime health
costs for all the babies born in a year would go up by $505 million.
That works out to $313 in added costs for every circumcision that
doesn't happen, the report said.

In this scenario, nearly 80% of the additional projected costs were
because of medical care associated with HIV infection in men, the team
wrote.

The model includes only direct medical costs such as treatment for
penile and cervical cancer, which are associated with HPV infection. It
doesn't consider nonmedical or indirect costs, such as transportation to
doctors' appointments or lost income. [Nor does it include costs for revision surgery or other sequelae of botched circumcisions.]
To Tobian, the message is clear: Government efforts to save money by
denying coverage for circumcision are penny-wise but pound-foolish.

"The federal Medicaid program should reclassify circumcision from an optional service to one all states should cover," he said.[So much for states' rights.]
That sentiment was echoed in an editorial accompanying the study.
UCLA health economist Arleen Leibowitz wrote that by failing to require
states to cover circumcision in Medicaid plans, the U.S. reinforces
healthcare disparities.

"If we don't give poor parents the opportunity to make this choice,
we're discriminating against their health in the future," she said in an
interview. "If something is better for health and saves money, why
shouldn't we do it? Or at least, why shouldn't we allow parents the
option to choose it?"

Ellen Meara, a researcher at the Dartmouth Institute for Health
Policy and Clinical Practice who was not involved with the study,
praised the researchers for conducting a careful analysis. But she questioned whether data from HIV studies in Africa were generalizable to the U.S. Medicaid population.

Still, it's "the best information we have," she said. "There's nothing better to plug in."[It's rigged, but it's the only game in
town. No US study has found sufficient evidence of a connection between
circumcision and HIV to justify doing it to babies.]
The analysis comes a week before the American Academy of Pediatrics
is scheduled to release a new policy on circumcision. Since 1999, the
doctors group has taken a neutral stance on the procedure, saying that
"the scientific evidence demonstrates potential medical benefits" but
that it's not strong enough to say that circumcision should be routine.

Some reports have indicated that the new policy will state that the
health benefits of circumcision outweigh the procedure's risks, but will
stop short of recommending it for all baby boys. A spokeswoman for the
academy declined to comment before the policy is formally released
Monday.
A shift in position could boost support for circumcision, since both
pediatricians and parents look to the academy for guidance, Leibowitz
said.

USC health economist Joel Hay said the new study was inherently flawed because ethical concerns about the procedure trumped any economic analysis of its potential benefits.

"You're taking an asymptomatic individual and forcing a procedure on him," he said.

Hay also argued that Americans didn't need circumcision to prevent
HIV infection because they had other options, such as using condoms. He
said that just last month the U.S. Food and Drug Administrationapproved
the use of a once-a-day pill called Truvada to reduce the risk of HIV
transmission in high-risk groups.

"There's no reason why people have to engage in this irreversible procedure," he said.

Tasmania: Non-religious infant circumcision should be illegal

The Tasmania Law Reform Institute today released Final Report No 17
on the legal framework in Tasmania which governs the practice of
non-therapeutic male circumcision. The report, Non-Therapeutic Male
Circumcision, provides background on the divisive issue of male
circumcision, examines the current law in Tasmania and other
international jurisdictions and offers recommendations for reform of the
law.

The TLRI produced an issues paper entitled Non-Therapeutic Male
Circumcision in 2009 seeking public views on the merits of the current
legal framework. The paper generated much interest, and submissions were
received not only from Tasmania and other Australian states but from
international respondents as well.

Analysis of the legal position reveals that the law is uncertain as
to whether non-therapeutic infant male circumcision is lawful. In the
interests of certainty the Institute recommends that the law be
clarified. The report makes a series of recommendations. These include:

a general prohibition on the circumcision of incapable minors with
an exception for well-established religious or ethnicity motivated
circumcisions.

enactment of legislation clarifying the legality of
circumcisions performed at the request of an adult or a capable minor
and governing situations where parents disagree about the desirability
of performing a circumcision.

greater dissemination of accurate information on the known and potential effects and significance of circumcision.

the imposition of criminal sanctions for a circumciser who fails to meet minimum standards of care: and

setting of a uniform limitations period in which individuals
can bring an action against their circumciser and extending the
limitations period for individuals harmed by circumcisions as a minor.

The report is available on the Institute’s webpage: www.law.utas.edu.au/reform

An exception should be granted for traditions such as the Jewish and Muslim faiths, it says.

"The law ought to accommodate established religious and ethnic circumcising traditions," the report says.

[But who is to decide which traditions are
established. Is Scientology established? The Unification Church
(Moonies)? The Mormons? Pastafarians? Jedi?]
"It should also support measures to encourage individuals associated
with these traditions to move away from loosely entrenched and
particularly contentious practices."

Among the other recommendations is the need for a court order for a
circumcision to take place if a child's parents disagree on it.

Pain and trauma affecting mental health can be associated with the
practice, while the benefit of fighting some infections is not
significant in developed countries, the report says.

Australia already has laws outlawing female genital mutilation but
the circumcision of boys has largely been considered a decision for
parents.

The report says more than 19,000 Medicare claims were lodged in 2010
for circumcisions performed on boys aged under six months throughout
Australia.

The rate has dropped from around 90 per cent in the 1950s to around
12 per cent in recent years, and is only around 1.5 per cent in
Tasmania.

Only Queensland public hospitals still perform the procedure, the report said.

International debate over the practice flared in June when a German
court ruled that it represented the illegal harming of a child.

The Royal Australian College of Physicians said at the time the practice was medically unnecessary and a choice for parents.

The state government will consider its response to the report, a spokesman said.

Parents held over genital mutilation

A man and a woman have been remanded into custody by Attunda district
court in Sollentuna on suspicion of having subjected their daughter to
female genital mutilation (FGM).

The couple who are both in their 30s are suspected of having allowed
the procedure to be carried out on their 3-year-old sometime between
January and April 2012 in either Sweden or Gambia.

Female genital mutilation has been illegal in Sweden since 1982.
Since 1999 it is an offence even if the procedure is performed in a
different country and carries a penalty of up to four years
imprisonment.

...

During the almost 30 years that FGM has been banned in Sweden, only
46 suspected cases have been reported, according to a report from
Uppsala University published last year.

...

Only two people have been convicted for female genital mutilation,
and in both cases it was the afflicted girls themselves who raised the
alarm.

KENYA PRISONERS BENEFITS FROM MALE CIRCUMCISION

By Maurice Alal
Prisoners in Nyanza Province of Kenya are currently benefiting
from Voluntary Medical Male Circumcision (VMMC) as one of the
educational programmes aimed at reducing HIV/AIDS prevalence rate in the
area.

The programme, which is an initiative of the government with
various health partners in the world, targets the prisoners, fishermen
among others who have not gone for the cut.

The demand for male circumcision in prisons is overwhelming
because the prisoners are the most neglected and at risk of HIV
infections. This is because of various behaviors in these institutions. [Yes, behaviours over which circumcision can have NO EFFECT.]"There are a lot of sexual activities such as homosexuals that exposes prisoners to high rate of infections.[... and probably IV drug use]
The prisoners come from different areas with unknown backgrounds,"
said the Social Mobilizer, Dan Aketch of Impact Research Development
Organization.
But Aketch noted with regret that the traditional practices by
Luo community have been a stumbling block towards ensuring that the
spread of the disease is reduced.

Some of the stumbling block included wife inheritance which the
community continue to adore and should be abolished immediately
especially at the beaches where the practice is rampant.

However, Nyanza Province Aids Prevention and STIs Coordinator Dr. Charles Okal asked the prisoners to embrace circumcision and behaviourial change to make sure they stick to one partner as a measure of bringing down the high rate of the scourge at the beaches and prisons.

"Male circumcision in prisons is on the right track and over 3000
prisoners have been cut so far," Dr. Okal disclosed, expressing hope
that 90% target will be achieved the end of 2013.

He however warned the prisoners who have undergone the cut to
guard against the unprotected sex especially those who have served their
jail term pointing out that male circumcision does not prevent one from
the scourge infections but only reduces it by 60%.

The medic urged the prisons management to carry out voluntary
counseling and testing and distribute condoms to prisoners especially
those that have serve the jail term when leaving for home.

"It is encouraging that circumcision has been impressed by
prisoners making turnout very high. If this continues the government
will be able to breathe a sigh of relief," Dr. Okal stated.

This has prompted the government in collaboration with other
organization such as Impact Research, Centre of Disease Control and
Prevention (CDC) and Nyarami to expand on VMMC alongside counseling and
testing.

According to HIV Counseling and testing officer of Nyarami in
Migori district, Mr. Dennis Owuor most prisoners are very happy of the
voluntary counseling and testing that is carried out in the prisons
department.

"Most of the prisoners after serving their jail term come to the
facility to take condoms for protection. This is because when in prisons
they do not know their partners HIV status," Owuor said.

...

However, a quarter of over 260, 000 men who
have been circumcised in Nyanza since 2008 through Voluntary Medical
Male Circumcision reducing chances of HIV infection by 60% are prisoners, Dr. Okal revealed.

[It seems clear that Dr. Okal has no idea how circumcision is supposed to prevent HIV, and is a victim of magical thinking.]
...

Puero Rico: Circumcision not protective

Circumcision does not protect men against HIV or other sexually transmitted diseases, according to a study conducted in Puerto Rico.

The 660 men were randomly sampled from an STD clinic waiting room. Almost a third of them were circumcised.

The circumcised men reported significantly (but not greatly) more
STDs in their lifetimes, were more likely to have been diagnosed with
warts, and were more likely to have HIV.

J Sex Med. 2012 Aug 15. doi: 10.1111/j.1743-6109.2012.02871.x. [Epub ahead of print]More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico.
Rodriguez-Diaz CE, Clatts MC, Jovet-Toledo GG, Vargas-Molina RL, Goldsamt LA, García H.AbstractIntroduction. Circumcision among adult men has been widely
promoted as a strategy to reduce human immunodeficiency virus (HIV)
transmission risk. However, much of the available data derive from
studies conducted in Africa, and there is as yet little research in the
Caribbean region where sexual transmission is also a primary contributor
to rapidly escalating HIV incidence.Aim. In an effort to fill the void of data from the
Caribbean, the objective of this article is to compare history of
sexually transmitted infections (STI) and HIV diagnosis in relation to
circumcision status in a clinic-based sample of men in Puerto Rico.Methods. Data derive from an ongoing epidemiological study
being conducted in a large STI/HIV prevention and treatment center in
San Juan in which 660 men were randomly selected from the clinic's
waiting room.Main Outcome Measures. We assessed the association between
circumcision status and self-reported history of STI/HIV infection using
logistic regressions to explore whether circumcision conferred
protective benefit.Results. Almost a third (32.4%) of the men were circumcised
(CM). Compared with uncircumcised (UC) men, CM have accumulated larger
numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048),
have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC =
12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).Conclusions. These analyses represent the first assessment of
the association between circumcision and STI/HIV among men in the
Caribbean. While preliminary, the data indicate that in and of itself,
circumcision did not confer significant protective benefit against
STI/HIV infection. [Actually, what the the data indicate is that intactness confers significant protection, compared to being circumcised.]
Findings suggest the need to apply caution in the use of circumcision
as an HIV prevention strategy, particularly in settings where more
effective combinations of interventions have yet to be fully
implemented. [They actually suggest that circumcision should notbe used because it isnota prevention strategy.]
...

Twin Boys' Genitals Amputated After Circumcision Op Goes Wrong

By Bryar Mohammed
Erbil - Two three-year-old twin brothers have had their genitals
amputated after a circumcision operation went horribly wrong in
Khanaqin.
Khanaqin hospital media official Arian Qader said: "Unfortunately an
unwanted incident occurred while circumcising the two boys. After the
operation went wrong, their penises were amputated. Now they urinate
using plastic tubes."
Qader said the doctor and assistant amputated the kids' genitals by mistake.
The official added: "When you circumcise a boy, there is a small tool
in our hospital that looks like an iron for amputating a small part of
the skin on the top of the penis."

"After the incident, both kids got gangrene, the disease of infection of the wound."
The genitals were ironed more than the normal procedure requires and
this led to infection. The boys' penises were later amputated.
The kids are Arab from Baladruz. Their father has registered a lawsuit against the doctor (I.A) and assistant.
Gangrene is a serious and life-threatening condition that arises when
a considerable mass of body tissue dies after an injury or infection.

Sunday, August 19, 2012

Man's foreskin goes missing

A man in Mangochi, on the southern tip of Lake Malawi, Stanley Kalonga woke up to a shocking sight of a missing foreskin from his member after two men forcefully circumcised him.

Police in Mangochi are keeping in custody the two men, 52-year-old Lanjesi Adam and Ali Suwedi, 43, who allegedly wounded the 29-year-old man amid speculation that the foreskin would be used for rituals.

Police spokesperson for Eastern Region Thomeck Nyaude said the incident happened on August 8 near Ntagaluka Mosque in Mangochi.

“Adam and Suwedi are currently in custody waiting for a court trial in which they will answer charges of unlawful wounding of Kalonga during a forced circumcision. The victim reported his ordeal to police before being referred to Mangochi District Hospital where he was treated as an outpatient,” said Nyaude.

He said that Kalonga plies [his trade as a] cyclist transporter at Mangochi town and on August 8, 2012 he was hired by Suwedi to take him to Ntagaluka Mosque where he ended up being forcefully circumcised.

“Kalonga explained that they stopped at Ntagaluka Mosque upon being advised by Suwedi that he wanted to collect some items in a nearby grass-thatched hut. Suwedi is said to have come out of the hut few minutes later and advised him to enter as well for some discussions.

“But when Kalonga entered, he found Suwedi’s accomplice Adam inside who smiled at him, saying he was welcomed. This shocked Kalonga who tried to escape but he was grabbed,” said Nyaude.

Then Suwedi undressed Kalonga as his counterpart Adam was preparing a razorblade which was used to circumcise him.

Within minutes, the compulsory mission was accomplished cutting off Kalonga’s foreskin. He spent a night there and he was released on August 9, 2012, the day he decided to report the matter to the police.

He said the police were still cross-examining the two suspects to establish their intention behind the forced circumcision on Kalonga.

Making HIV male circumcision programmes more sustainable

In some areas in the East African nation, the government partners are giving a token to those who come to be circumcised

NAIROBI (Xinhua) -- Kenya has stepped up efforts to increase access to Voluntary Medical Male Circumcision (VMMC) services in bid to make the programme sustainable.

Dr Athanasius Ochieng, VMMC Manager at National AIDS/STD Control Programme (Nascop) said ...The more people we circumcise, the more the costs go down because of economies of scale,” ...

Ochieng explained that Kenya is seeking to bring down the cost to 27 dollars per individual.

The VMMC expert noted that currently, the government and its partners are using about 40 U.S dollars to circumcise every man in the programme that has received praise across the world.

“This is too expensive for the government and donor partners. It is unsustainable. The costs can come down only if the number of people who are circumcised increases,” he said.

“This can come down further if the number of people increases. A huge number in every centre will ensure that the surgeons and other staff are effectively utilised,” he said. Currently, he noted that some centres do not achieve their targets, which makes costs go up because the surgeons, who are on salary, are paid yet they are not efficiently utilised.

To increase the number of people accessing the services, Ochieng said the government is targeting older men above 55 years and women. [???]

“Most of those people who have gone through VMMC are younger men below 25 years. This shows that there is a gap in the other age groups. We have initiated campaigns to reach out to the older men, who statistics indicate are exposed to HIV virus due to cultural practices, among other things,” he said. [So wouldn't it make more sense to address the cultural practices?]

...

Ochieng said they are holding more sensitisation [!] forums in the region and in the capital, where more people have also undergone the cut to create demand.

...

“Among old men, we found out that stigma and age is a great concern. Many old people believe that due to their advancing age, they do not need to undergo the cut since they may not be predisposed to HIV but this is not the case,” he said.

Fear of stigma is another concern for old men because many note they should not get circumcised at the same time with men young enough to be their children.

For women, Onchiri said that they are using them to reach out to men and their sons.

“Experience has shown that women are good agents, who can convince their men and sons to get circumcised,” he said.

Research indicates that male circumcision is beneficial to both men and women.

“VMMC reduces the risk of HIV infection among men and limits women’s exposure to the virus. This makes the procedure the best method in fighting HIV,” said Onchiri. [But condoms provide strong, directprotection tobothpartners.]

In some areas in the East African nation, Ochieng explained that government partners are giving a token to those who come to be circumcised.

“Those who come to VMMC centres are given some small amount of money, about 2 dollars so that this can encourage their colleagues to visit the centre for the minor surgery,” said Ochieng, who noted that the method is being used in Turkana.

Kenya, according to Nascop, is also considering introducing infant and early childhood VMMC to boost male cut for health reasons. [No infant has ever volunteered for circumcision. No study has ever shown any effect of infant circumcision on HIV transmission.]

According to Nascop, Kenya intends to circumcise 860,000 men by 2014. “If we achieve our target by that year, we would have averted about 2 million HIV infections by the year 2025,” he said.[That figure is Just Made Up.]

Against circumcision of boys

By Gert van Dijk

Recently an article appeared in KN by Rabbi Lody van de Kamp, who hauls me over the coals [literally "breaks the staff"] about the fact that the Royal Dutch Medical Association (KNMG) advocates to discourage circumcision of boys. Yet the reasons for such discouragement are clear.

Circumcision of boys may be performed only by physicians, when there are medical benefits attributed, and doctors are often confronted with complications of circumcision. Circumcision is contrary to the cardinal rule for doctors 'in the first place, do no harm' and to the rule that children who are not able to decide should only be treated when it is necessary for them medically. That is the premise of the KNMG, the organization of and for physicians.

DestructivenessThe International Convention on the Rights of the Child (ICRC) says that the government is required to ensure that harmful traditional practices be abolished. The science is undeniable that circumcision is harmful. A circumcision means 25 to 50 percent of the healthy tissue of the penis is removed. A man's [fore]skin has about the surface area of a postcard. Immediately after the operation, an infection or bleeding occurs in two to five percent of the boys, which sometimes requires hospitalization.

Many boys (up to twenty percent) later get a stricture of the urethra, causing problems with urination and possibly bladder problems. Still later circumcised men and their partners get sexual problems more often than non-circumcised men, because a circumcised penis is less sensitive. Also, many men complain about the fact that they were circumcised without their consent. Any medical benefits - such as a possible reduced risk of HIV transmission - are relevant at a later age and are no justification for circumcision in childhood.

DiscriminatoryThe ICRC also says that there may not be discrimination between boys and girls. It is also noteworthy that in the Netherlands all forms of female circumcision are forbidden - even in symbolic form, with no tissue being removed - but that circumcision of boys is tolerated. Are Jewish and Muslim boys not equally protected by law as girls?

Religious freedom or physical integrity?The debate about circumcision of boys is often seen as a contradiction between the right of the child to physical integrity and the right of parents to religious freedom. What emerges is often forgotten, that the ICRC also guarantees the child's right to freedom of religion. This freedom implies that it is permissible for a child to be educated in religion, but that the child should keep the freedom to choose a different opinion later. This means that the child should remain protected from irreversible physical religious characteristics.

A German court recently ruled that the right to religious freedom of parents is limited by the right to physical integrity of the child. This legal ruling fits into a debate about circumcision of boys being conducted in almost the entire Western world, even within religious groups. In Israel, a growing group of parents refrain from circumcising.

Social pressureMany parents who still perform circumcision do so because of social pressure from their parents and grandparents, not from religious feelings. In America, a growing group of Jewish parents, together with religious leaders, have developed alternative rituals in which the child can be included in the religious community, but the integrity of the child's body is not violated.

Growing resistanceThe growing resistance against boys' circumcision is not only from medical and secular society, but also from the religious community itself. The debate has nothing to do with antisemitism or anti-religion, as is sometimes suggested. It is a manifestation of a growing awareness that children have the same fundamental rights as adults. If it is not permissible for a man to be circumcised against his will; why may or should a child be?

Personal choiceCircumcision is a personal choice for which people have different reasons. Fortunately we live in a country where people are free to make that choice. But let it be a choice that the person himself makes, because ultimately there is only one person who should decide whether or not to remove a healthy part of the body, and that is the man himself.

[The rabbi took van Dijk to task for saying the Cologne decision was "historical" i.e. epoch-making, with snide references to Nazi history - against which the German Basic Law was a reaction! - and to some case in which a woman died. Basically, anything but discuss the ethics of cutting babies' genitals.]